Psychiatric medications, science, marketing, psychiatry in general, and occasionally clinical psychology. Questioning the role of key opinion leaders and the use of "science" to promote commercial ends rather than the needs of people with mental health concerns.

Monday, October 06, 2008

The psychiatry world is belatedly exhibiting outrage toward a man whose ability to lure pharma cash seems to know no bounds. He may be the textbook case of a key opinion leader. Of course, I speak of Charles "Bling Bling" Nemeroff. Rather than list the many questionable at best behaviors he has exhibited, each of which has called into question his standing as a scientist as opposed to a blatant drug marketer, I just want to a) direct everyone to a detailed list of his speaking engagements from GlaxoSmithKline and b) discuss a month of living the High Life, Nemeroff Style.

As is well known by now (1, 2), Nemeroff appears to have not been particularly forthcoming about the huge amounts he was making while moonlighting for every drug company on the planet (see below) despite requirements that he do so. According to psychiatrist Danny Carlat:

From 2000 to 2006, GSK paid Nemeroff a total of $960,488. Note that this was not research grant money, or money for Emory's psychiatry department. These were fees that went into his personal bank account, which he earned by either sitting on GSK's Advisory Board, or speaking to doctors about GSK products. His typical fee for a talk was $3500 plus expenses, but sometimes he made more.

Of this $960,488, the total amount he disclosed to Emory [his employer, to whom he was required to report such income] was $34,998.

According to a GSK document hosted by Senator Charles Grassley, Nemeroff took in over $20 grand in one month from speaking engagements for GSK. Not bad work if you can get it, eh? And this month doesn't seem unusual for Nemeroff. These are only his speeches for GSK -- he also gave speeches for several other companies. The document goes on and on -- 39 pages of paid speech listings, nearly all of them featuring Nemeroff. I just picked 03-30-00 to 04-30-00 because they were on the first pages of the document, which covers expenses from 2000 to 2008 for Dr. Bling Bling.

Nemeroff GSK Honoraria from March 30, 2000 to April 30, 2000

Date

Speaking Fee

03/30/2000

$4000

04/12/2000

$2500

04/19/2000

$4000

04/20/2000

$4175 (includes some 'expenses'; I suspect $4000 was the speaking fee)

04/27/2000

$4000

04/30/2000

$2500

TOTAL

$21, 175 (probably $21,000 excluding travel expenses)

Imagine making $20k in a month for basically reading slides a few times that were quite possibly entirely written by a drug company. And many of these talks were accompanied by posh meals, the kind that myself and most of my readers might eat once or twice a year.

Here's a Nemeroff disclosure from a recent journal article:

Dr Nemeroff has received grants from or performed research for the American Foundation for Suicide Prevention, AstraZeneca, Bristol-Myers Squibb, Forest Laboratories, Inc, Janssen Pharmaceutica, NARSAD: TheMental Health Research Association, the National Institute of Mental Health, Pfizer Pharmaceuticals, and Wyeth-Ayerst Laboratories; has been a consultant to Abbott Laboratories, Acadia Pharmaceuticals, Bristol-Myers Squibb, Corcept Therapeutics, Cypress Bioscience, Cyberonics, Eli Lilly and Co, Entrepreneur’s Fund, Forest Laboratories, Inc, GlaxoSmithKline, i3 DLN, Janssen Pharmaceutica, Lundbeck, Otsuka America Pharmaceutical, Inc, Pfizer Pharmaceuticals, Quintiles Transnational, UCB Pharma, and Wyeth-Ayerst Laboratories; has been on the speakers bureau for Abbott Laboratories, GlaxoSmithKline, Janssen Pharmaceutica, and Pfizer Pharmaceuticals; is a stockholder in Acadia Pharmaceuticals, Corcept Therapeutics, Cypress Bioscience, and NovaDel Pharma Inc; is on the board of directors of the American Foundation for Suicide Prevention, the American Psychiatric Institute for Research and Education, the George West Mental Health Foundation, NovaDel Pharma Inc, and the National Foundation for Mental Health; holds patents on a method and devices for transdermal delivery of lithium (US 6,375,990 B1) and on a method to estimate serotonin and norepinephrine transporter occupancy after drug treatment using patient or animal serum (provisional filing April 2001); and holds equity in Reevax, BMC-JR LLC, and CeNeRx.

No, I didn't make that up. As Ed Silverman wrote at Pharmalot, "It also raises a question - when he did find time to do anything else?"

Mind you, I am not here to justify Dr. Nemeroff's bad behavior. To not disclose the payment of more than $10,000 a year from a drug company that makes a drug you are also studying with an NIH funded grant is clearly a violation of NIH policy (although not a violation of the law).

However, when I was attacked by a drug company, Nemeroff was the ONLY person at Emory to come to my defense

http://www.beforeyoutakethatpill.com/blog.thml

I think you need to take personal character into account before you rush to judgment. He had NO personal incentive to defend me. He did it out of principle.And in fact he and EVERYONE at Emory was nervous by my behavior. In fact Emory refused to issue a press release about my book.

I have some questions for the Senator.

First off, why are you only investigating psychiatrists? [Answer: psychiatrists have an approval rating in medicine that is only above chiropractors. Many people blame paxil for their problems. It is low hanging fruit]

Second, why don't you look at other specialties? Take a look at cafepharma.com, where the drug reps are gossiping in relation to the Nemeroff dispute that "key opinion leaders" for advair are at the front of the gravy train. [Answer: cardiologists make life saving drugs, while psychiatrists are pseudoscientists who are trying to invent a myth about serotonin imbalance so they can help sell drugs for their cronies, the drug companies.] [Answer to answer: Not true. You have to treat 100 heart disease patients with Lipitor to prevent one heart attack, while you treat only 8-17 depressed patients with an antidepressant to prevent a recurrence. And if you don't believe that depression is as bad as a heart attack, ask someone who has been there.]

Ask anyone who works in a university hospital. If their docs have any talent, they are never there. It is because they are always away giving talks for pharma. And pretty much all of it is undisclosed. The ones who are complaining about it are the losers who pharma doesn't want to lecture for them anyway.

Senator Grassley, if you really want to get to the bottom of the corruption that has permeated academic medicine, do a nation wide audit. Of ALL specialties. If you don't, you are a hypocrite.http://www.beforeyoutakethatpill.com/blog.html

As a rep with a top ten pharma company, my last year doing that kind of work, I spent close to 40 grand on lunches in one year. Add another 60 grand for speaking engagements, known as 'peer-to-peer selling. No way to measure return on investment with pharma spending accurately. It's mainly speculative.

It is a shame you seem to update your site so infrequently, because you offer info of interest and need.

I can't speak for anyone else but myself, but it is getting difficult to come here more often than every 3 to 5 days of late as there are few postings or commentary by readers. Maybe I'm wrong, but some regularity does promote interest.

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About Me

I'm an academic with a respectable amount of clinical experience and no drug industry funding. Given my lack of time, don't expect multiple daily updates. Certain things about clinical psychology, the drug industry, psychiatry, and academics drive me nuts, and you'll probably pick up on these pet peeves before long...